| NPI | 1881077907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60833718) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1856938) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2019-04-04 |